Remote Pharmacy Technician

Remote Pharmacy Technician Prior Authorization (Medicare & Medicaid)This role focuses on supporting Medicare and Medicaid patients by processing and reviewing medication prior authorizations in a fully remote environment. You will begin by handling intake of prior authorization requests and progress to performing detailed technical reviews to determine coverage decisions. The position combines pharmacy expertise, data entry, and phone-based customer service, requiring strong attention to detail, comfort with clinical and insurance documentation, and the ability to work independently while maintaining strict confidentiality.ResponsibilitiesProcess incoming MedPharm prior authorization requests for Medicare and Medicaid patients, with a primary focus on Medicare cases.Perform intake of prior authorization cases by gathering required information, accurately entering data, and setting up cases in internal systems.Route completed intake cases to the review team and support efficient workflow between intake and review functions.Receive prior authorization cases from the intake team and conduct thorough technical reviews to determine medication coverage.Read and interpret clinical criteria, standard operating procedures (SOPs), insurance documents, and medical documents to assess eligibility.Make clinical determinations on whether medications are approved, denied, or covered in any capacity, following established guidelines.Document decisions clearly and accurately in the system, ensuring all required information and rationale are recorded.Communicate with customers and healthcare professionals over the phone, handling inquiries related to prior authorizations and coverage decisions.Provide professional customer service by controlling conversations, redirecting calls when necessary, and resolving issues efficiently.Maintain high levels of accuracy in data entry, documentation, and case handling to support quality and compliance standards.Protect patient privacy by following HIPAA requirements and working in a secure, confidential environment.Collaborate with team members in a remote setting, supporting a positive culture and contributing to overall team performance.Adapt to rotating holiday coverage and flexible scheduling needs as part of a shared team schedule.Essential SkillsCurrent pharmacy technician experience with exposure to pharmacy operations.Pharmacy technician certification (such as CPhT) or equivalent credential, as required for the role.Hands-on experience in managed care or working with managed care organizations.Prior experience processing or supporting prior authorizations in a pharmacy, managed care, or similar setting.Strong data entry skills with a high level of accuracy and attention to detail.Proficiency with computer systems and the ability to learn new software and internal platforms.Customer service experience over the phone, including managing calls, controlling conversations, and redirecting discussions when needed.Ability to read and interpret insurance documents, SOPs, and medical documentation to support coverage decisions.Demonstrated ability to work independently in a remote environment while meeting productivity and quality expectations.Strong organizational skills and the ability to manage multiple cases and tasks simultaneously.Commitment to maintaining confidentiality and complying with HIPAA requirements.Additional Skills & QualificationsPrevious experience working with Medicare and Medicaid patient populations.Experience in claims, managed care pharmacy, or similar healthcare administrative functions.Experience in a high-volume customer service or call center environment.Comfort working with clinical criteria and making coverage-related determinations under established guidelines.Strong written and verbal communication skills to document decisions and communicate clearly with patients and providers.Ability to adapt to rotating holiday coverage and flexible scheduling, including evening and weekend shifts.Interest in working in a culture-focused organization with a strong internal engagement score and emphasis on flexibility, paid time off, holidays, and benefits.Work EnvironmentThis is a 100% remote position that requires working from a closed-door setting with limited distractions to ensure confidentiality and compliance with HIPAA. You must have reliable, strong Wi-Fi and a suitable home office or dedicated workspace that supports focused, uninterrupted work. Training runs Monday through Friday from 10:00 a.m. to 6:30 p.m. Eastern Time. After training, schedules follow either a SundayThursday or TuesdaySaturday pattern. For a SundayThursday schedule, preferred hours are 12:008:30 p.m. or 12:309:00 p.m. Eastern Time, with Sunday typically scheduled from 8:00 a.m. to 4:30 p.m. Eastern Time. For a TuesdaySaturday schedule, preferred hours are 12:309:00 p.m. Eastern Time on Tuesday through Friday, with Saturday typically scheduled from 8:00 a.m. to 4:30 p.m. Eastern Time. Holiday coverage rotates among team members. Lunch breaks range from 30 minutes up to one hour, depending on schedule and business needs. The role is computer-based and phone-intensive, requiring consistent use of digital tools, case management systems, and communication platforms in a professional, remote work environment.Job Type & LocationThis is a Contract to Hire position based out of Orlando, FL.Pay and BenefitsThe pay range for this position is $24.00 - $25.00/hr. Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: Medical, dental & vision Critical Illness, Accident, and Hospital 401(k) Retirement Plan Pre-tax and Roth post-tax contributions available Life Insurance (Voluntary Life & AD&D for the employee and dependents) Short and long-term disability Health Spending Account (HSA) Transportation benefits Employee Assistance Program Time Off/Leave (PTO, Vacation or Sick Leave)About ActalentActalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 20,000 consultants and 5,000 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. We are proud to be an Engineering News-Record (ENR) Top 500 Design Firm for our engineering design services and a ClearlyRated Best of Staffing® winner for both client and talent service.The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email View email address on click.appcast.io for other accommodation options.San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.